Primary Care Physicians' Attitudes and Practices Regarding Discussing Organ Donation with Their Patients

What would happen if discussions about organ donation took place at the doctor’s office rather than at the Department of Motor Vehicles or in the intensive care unit?

Daryl Thornton, M.D., M.P.H., an intensivist, an assistant professor of medicine at Case Western Reserve University, and an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Harold Amos Medical Faculty Development Programs, has the answer. The 100,000-plus people now waiting for lifesaving organ transplants—a disproportionate number of whom are minorities—may be more likely to get them, he says.

His response is based on the results of a groundbreaking study he conducted that examines doctors’ general reluctance to discuss organ donation with their patients even though most agree it falls within the scope of their practice and most patients expect it.

“The Department of Motor Vehicles (DMV) may be a convenient place to discuss organ donation because it enables people to indicate their willingness to donate on their drivers’ licenses,” he says. “But it’s not an optimal place from an educational standpoint because DMV staff do not have the time or the knowledge to sufficiently educate patients about organ donation.”

Obtaining consent for organ donation at the time of death, of course, is also “fraught with difficulties,” Thornton and his colleagues write. Many people have not signed a donor card prior to their death, leaving consent up to family members. Not surprisingly, many families decline. Moreover, critical care physicians often do not feel comfortable seeking consent from family members or surrogates of their recently deceased patients.

But if more people learned about the risks and benefits of organ donation from their primary care physicians—with whom they have an established relationship—they might be more willing donors, Thornton says. And that would help save countless lives.

Early Interest in Organ Transplants

Thornton first became interested in the subject while working as a fellow in an intensive care unit. During this period, he saw a lot of people pass away; many were unable to donate because their families were unwilling to provide consent. At the same time, Thornton cared for numerous patients who died because they were not able to wait long enough to receive organs. “I was always curious about that disconnect,” he says.

He began to look further into the discrepancy a decade ago as a RWJF Clinical Scholar. In 1999, he studied barriers to organ donation for specific populations and found that patients who had signed living wills were more likely to become donors, as were those who had previous experience with organ donation. But the most influential factor, he found, was whether a person had discussed the possibility with his or her physician.

Thornton took those findings to the next level as a Harold Amos Program Scholar. Thornton and his colleagues—one of whom, Randall Curtis, M.D., M.P.H., is a former Clinical Scholar—surveyed a random national sample of more than 700 primary care physicians to find out how often physicians discussed organ donation with their patients and what factors facilitated or inhibited those discussions.

They found that only a small fraction of physicians raise the matter with their patients, even though almost all support it and most believe it falls within the scope of their practices. Those who do initiate such discussions are often already educated about organ donation or regularly discuss end-of-life care with their patients, they found.

Many physicians don’t feel comfortable discussing organ donation because they have not been trained to do so or because they feel they do not have enough time to discuss the matter with patients because of heavy patient loads or insufficient staff levels, Thornton says.

“The heavy patient load is certainly a concern,” he says. But training doctors to raise the matter with patients and educating them about how to do so in a timely manner is feasible—and effective. Such discussions, he says, could be incorporated quickly and easily into the end-of-life discussions that many doctors have with their patients.

“We do a wonderful job in medical school teaching about diseases and their treatments, including transplantation,” he says. “But we could do a better job of talking to our young physicians about the need to improve organ donation to be able to cure many of these diseases and improve the quality and duration of life for our patients.”

The Robert Wood Johnson Foundation Clinical Scholars program fosters the development of physicians who will lead the transformation of Americans’ health and health care.

The Harold Amos Medical Faculty Development Program seeks to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine.

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